Promoting smoking cessation in Pakistani and Bangladeshi men in the UK: pilot cluster randomised controlled trial of trained community outreach workers

Abstract

BackgroundSmoking prevalence is high among Pakistani and Bangladeshi men in the UK, but there are few tailored smoking cessation programmes for Pakistani and Bangladeshi communities. The aim of this study was to pilot a cluster randomised controlled trial comparing the effectiveness of Pakistani and Bangladeshi smoking cessation outreach workers with standard care to improve access to and the success of English smoking cessation services.MethodsA pilot cluster randomised controlled trial was conducted in Birmingham, UK. Geographical lower layer super output areas were used to identify natural communities where more than 10% of the population were of Pakistani and Bangladeshi origin. 16 agglomerations of super output areas were randomised to normal care controls vs. outreach intervention. The number of people setting quit dates using NHS services, validated abstinence from smoking at four weeks, and stated abstinence at three and six months were assessed. The impact of the intervention on choice and adherence to treatments, attendance at clinic appointments and patient satisfaction were also assessed.ResultsWe were able to randomise geographical areas and deliver the outreach worker-based services. More Pakistani and Bangladeshi men made quit attempts with NHS services in intervention areas compared with control areas, rate ratio (RR) 1.32 (95%CI: 1.03-1.69). There was a small increase in the number of 4-week abstinent smokers in intervention areas (RR 1.30, 95%CI: 0.82-2.06). The proportion of service users attending weekly appointments was lower in intervention areas than control areas. No difference was found between intervention and control areas in choice and adherence to treatments or patient satisfaction with the service. The total cost of the intervention was £124,000; an estimated cost per quality-adjusted life year (QALY) gained of £8,500.ConclusionsThe intervention proved feasible and acceptable. Outreach workers expanded reach of smoking cessation services in diverse locations of relevance to Pakistani and Bangladeshi communities. The outreach worker model has the potential to increase community cessation rates and could prove cost-effective, but needs evaluating definitively in a larger, appropriately powered, randomised controlled trial. These future trials of outreach interventions need to be of sufficient duration to allow embedding of new models of service delivery.Trial registrationCurrent Controlled Trials ISRCTN82127540

Smokeless tobacco cessation in South Asian communities: a multi‐centre prospective cohort study

“…Results from other smokeless tobacco trials have reported the value of NRT in reducing withdrawal symptoms and NRT-related adverse events during quit attempts [13][14][15][16][17][18][19]. Participant satisfaction with English NHS SSS has been reported previously to be high [23,33]. Oral pain was reported commonly by clients at the start of the quit attempt, as in a previous study [9].…”

“…A cessation trial with male smokers of South Asian (Pakistani, Bangladesh) origin has also indicated the benefits of providing a specialist outreach service for otherwise 'hard-to-reach' participants [23].…”

“…These two reports provided no data on the quitting process, such as withdrawal symptoms, adverse events or participant satisfaction. A third study has compared the outcomes of an outreach project for Pakistani and Bangladeshi male smokers with the standard NHS SSS [23]. The potential to increase cessation attempts and a small increase in the number of 4-week abstinent smokers was reported.…”

The organisation and delivery of health improvement in general practice and primary care: a scoping study

“…The main exception was in relation to smoke-stop services, where services to support quitting are viewed as cost-effective and approaches that provide ongoing support for smokers wanting to stop, or those who have quit, delivered in a targeted way, are more likely to be effective. 252,[439][440][441][442] In addition, there is still potential for better identification of smokers and raising smoking awareness by a range of health and other care professionals. The evidence to support interventions for increasing exercise or reducing weight was limited and suggested that such approaches in primary care or in schools have little impact and that any benefit is generally only short-term.…”

“…[248][249][250] However, few studies examined specific population groups although one study suggests a lack of services for ethnic minority groups despite some evidence of the benefit of community outreach services. 251,252 Identifying strategies to find and support smokers from disadvantaged groups is, therefore, of key importance. 253 This systematic review identified 48 papers.…”